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if <br /> Date run 10/4/2010 8:56:17AN SAN JOAnUIN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report#5021 <br /> Run by 4006 Facility Information as of 10/4/2010 Pagel <br /> Record Selection Criteria: Facility ID FA0014022 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0011097 New Owner ID <br /> Owner Name ST SERVICES <br /> Owner DBA ST SERVICES <br /> Owner Address 2801 WATERFRONT RD <br /> MARTINEZ, CA 94553 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 2801 WATERFRONT RD <br /> MARTINEZ, CA 94553 <br /> Care of RICHARD BRANDIES <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014022 <br /> Facility Name ST SERVICES <br /> Location 2941 NAVY DR <br /> STOCKTON, CA 95206 <br /> Phone <br /> Mailing Address 2801 WATERFRONT RD <br /> MARTINEZ, CA 94553 <br /> Care of RICHARD BRANDES <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION `` _ � n <br /> Contact Name ST SERVICES Afif Ckg&4np` /4 SSoe- H'�-S -41 L- <br /> Title alz,, SW fC <br /> Day Phone d Tt_ cf-7201~t4-707 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0023735 New Account ID: <br /> Mail Invoices to Account ­` Mail Invoices to: Owner / Facility / Account <br /> Account Name ASH CREEK ASSOCIATES (Circle One) <br /> Account Balance as of 10/4/2010: $427.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB SITE PR0518632 EE0000997-HARLIN KNOLL Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. ,r �,17� 1 <br /> APPLICANT'S SIGNATURE: r V` l� F-r l�`�-�`-� Or :4 tty� � Date <br /> Program Records to be TRANSFERED: `$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date / / <br /> Payment pe Check Number Received by <br /> REHS: Date I / /� Account out: Date �01�1 l <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />